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WALK 2.0 - Using Web 2.0 applications to promote health-related physical activity: A randomised controlled… Kolt, Gregory S; Rosenkranz, Richard R; Savage, Trevor N; Maeder, Anthony J; Vandelanotte, Corneel; Duncan, Mitch J; Caperchione, Cristina M; Tague, Rhys; Hooker, Cindy; Mummery, W K May 3, 2013

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STUDY PROTOCOL Open AccessWALK 2.0 - Using Web 2.0 applications topromote health-related physical activity: Arandomised controlled trial protocolGregory S Kolt1*, Richard R Rosenkranz1,2, Trevor N Savage1, Anthony J Maeder3, Corneel Vandelanotte4,Mitch J Duncan4, Cristina M Caperchione5, Rhys Tague3, Cindy Hooker4 and W Kerry Mummery6AbstractBackground: Physical inactivity is one of the leading modifiable causes of death and disease in Australia. Nationalsurveys indicate less than half of the Australian adult population are sufficiently active to obtain health benefits. TheInternet is a potentially important medium for successfully communicating health messages to the generalpopulation and enabling individual behaviour change. Internet-based interventions have proven efficacy; however,intervention studies describing website usage objectively have reported a strong decline in usage, and highattrition rate, over the course of the interventions. Web 2.0 applications give users control over web contentgenerated and present innovative possibilities to improve user engagement. There is, however, a need to assess theeffectiveness of these applications in the general population. The Walk 2.0 project is a 3-arm randomised controlledtrial investigating the effects of “next generation” web-based applications on engagement, retention, andsubsequent physical activity behaviour change.Methods/design: 504 individuals will be recruited from two sites in Australia, randomly allocated to one of twoweb-based interventions (Web 1.0 or Web 2.0) or a control group, and provided with a pedometer to monitorphysical activity. The Web 1.0 intervention will provide participants with access to an existing physical activitywebsite with limited interactivity. The Web 2.0 intervention will provide access to a website featuring Web 2.0content, including social networking, blogs, and virtual walking groups. Control participants will receive a logbookto record their steps. All groups will receive similar educational material on setting goals and increasing physicalactivity. The primary outcomes are objectively measured physical activity and website engagement and retention.Other outcomes measured include quality of life, psychosocial correlates, and anthropometric measurements.Outcomes will be measured at baseline, 3, 12 and 18 months.Discussion: The findings of this study will provide increased understanding of the benefit of new web-basedtechnologies and applications in engaging and retaining participants on web-based intervention sites, with the aimof improved health behaviour change outcomes.Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12611000157976Keywords: Physical activity, Randomised controlled trial, Internet* Correspondence: g.kolt@uws.edu.au1University of Western Sydney, School of Science and Health, Sydney, NSW,AustraliaFull list of author information is available at the end of the article© 2013 Kolt et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the CreativeCommons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, andreproduction in any medium, provided the original work is properly cited.Kolt et al. BMC Public Health 2013, 13:436http://www.biomedcentral.com/1471-2458/13/436BackgroundPhysical inactivity remains one of the leading modifiablecauses of death and disease in Australia [1]. Regularphysical activity (PA) decreases the risk of developingcardiovascular disease, diabetes, some cancers, obesity,osteoporosis, and other chronic conditions [2], but na-tional Australian surveys indicate that almost 60% ofAustralians aged 15 years and over do not undertakesufficient PA to obtain health benefits [3]. It has been es-timated that physical inactivity contributes to more than8,000 deaths in Australia each year, and that for every1% increase in the Australian population becoming suffi-ciently physically active some $7.2 million in health carecosts could be saved [4]. Novel approaches for increasingPA with the potential to reach broad populations at anacceptable cost are needed.Interventions delivered via the Internet have emergedas a novel and popular health promotion strategy, withthe potential for wide population reach. The Internetis potentially an important medium in communicatingmessages associated with raising the profile of PA to thegeneral population [5,6]. Over the past decade, there hasbeen unprecedented growth in the use of the Internetworld-wide [7,8]. For example, in Australia (the focus ofthis trial) in 2010–2011 79% of homes had Internet ac-cess and there were over 6.2 million households withbroadband Internet access (73% of all homes), showing afive-fold increase over the past ten years in Australia [9]and six-fold increase worldwide [7]. Internet users are alsobecoming more representative of the overall population,as more women, elderly, and people from low socio-economic background are going online [10]. The ex-ponential growth of the Internet has been paralleled by re-search into the uses of the Internet for social marketingand health promotion [11]. Recent reviews of the effective-ness of Internet-based PA interventions have also demon-strated the short-term efficacy of this medium forindividual behavioural change, but also the need to in-crease user interaction and retention to websites to in-crease long-term behavioural outcomes [12-15].To obtain the social marketing, health promotion, andbehavioural change benefits associated with Internet-delivered PA interventions, the engagement and reten-tion of participants in larger and more representativestudy samples must be addressed [15]. Intervention stu-dies that have provided objective data on website usagehave reported a strong decline in usage, and high attri-tion rate over the course of the intervention [15]. A lowlevel of website interactivity has been suggested as anexplanation for the modest retention and engagementrates within these health promotion trials [16]. There isconsensus in the literature that website-delivered be-havioural change interventions with a high degree ofinteractivity are more effective in producing behaviourchange compared to those with a low degree of inter-activity [17,18].Web 2.0 represents the newest generation of Internet-based, highly interactive applications, which are aimedat giving users control of how information is genera-ted, created, and shared. Web 2.0 applications, includingblogs, wikis, podcasts, mash-ups, and social networkingsites, are widely embraced and their popularity continuesto grow. For example, in Australia, there are currentlyover 11 million people who use the social networkingwebsite Facebook, with 75% of users going to the site atleast once a day [19]. Hence, there are a growing num-ber of speculative theses on the potential of Web 2.0 ap-plications in the fields of health and medicine [20-24].There is a clear need for larger population studies toexamine this next generation of web-based applications(Web 2.0) and to study their effectiveness relative toconventional web-based approaches (Web 1.0), particu-larly with regard to participant engagement, retention,and PA behaviour change.The 10,000 Steps program is one example of a novelPA promotion project that was initially established as awhole-of-community study known as the 10,000 StepsRockhampton project [25,26]. Since the completion ofthe original project, the program has continued to bedisseminated at the individual and community levels [5].A key element of the dissemination of the program hasbeen the use of the Internet to promote and support PA.The 10,000 Steps website has been used to disseminatePA information to health professionals and to provideengagement of registered members through the use ofan online step log. The website is generally used in con-junction with a pedometer, one of the novel elements ofthe original program, and web-based ‘i-challenges’ and‘virtual journeys’. The 10,000 Steps website has demon-strated that the self-monitoring characteristic of the site(use of i-challenges) is a strong factor in retaining users[27,28]. This is consistent with research demonstratingthat pedometers are useful as self-monitoring and motiv-ational tools, and also a significant factor in increasingPA in a broad range of population groups includingpeople with type 2 diabetes [29], insufficiently activewomen [30], and people engaged in a web-based work-site PA program [31]. Pedometer step logs, in con-junction with activities such as challenges and ‘virtualjourneys’, are basic examples of the type of interactivitythat can be created using Web 1.0 technology, whichmay further enhance the capacity of websites to retainusers and produce more sustainable changes in PA.In this study we plan to compare the use of Web 1.0applications, as applied in the Australian 10,000 Stepswebsite, with Web 2.0 applications. Our aim is to inves-tigate the effects of “next generation” web-based applica-tions (e.g. social networking), to establish whether WebKolt et al. BMC Public Health 2013, 13:436 Page 2 of 9http://www.biomedcentral.com/1471-2458/13/4362.0 technology can outperform Web 1.0 technology interms of website engagement, retention and subsequentPA behaviour change.Primary Hypothesis:H1: Participants in the Web 2.0 condition will displayhigher levels of physical activity at 3 months, and at 12and 18 months post intervention, compared with theWeb 1.0 or control condition.Secondary Hypothesis:H2: There will be significantly greater website engage-ment and participant retention on the website in theWeb 2.0 arm of the study than in the conventional(Web 1.0) condition at 3 months, and at 12 and 18months post intervention.Methods/designTrial designThe Walk 2.0 project is a three-arm randomised con-trolled trial (RCT) investigating the effectiveness of twoweb-based PA interventions and a logbook PA interven-tion (Figure 1). Outcomes will be assessed at baseline,and at 3, 12, and 18 months. The study has receivedethics approval from the Human Research Ethics Com-mittees of the University of Western Sydney (Referencenumber H8767) and CQUniversity (H11/01-005). Thestudy will be reported according to CONSORT guide-lines [32].Participants and recruitmentA total of 504 participants will be recruited for thisstudy across two sites in Australia (South WesternSydney and Central Queensland). The primary means ofrecruiting participants will be a personalised invitationletter to an extract of randomly selected individuals fromthe Australian Electoral Commission (AEC) electoralroll. Voting is compulsory for persons aged 18 years andover in Australia and AEC data provides an effectivemeans of sampling the targeted population. Previous re-search utilising a similar method to recruit participants,but requiring mainly survey-based cohort measure-ments, reported that between 60 and 70% of individualsinvited to a research project using this manner, partici-pated [28,29]. The participant requirements of this re-search, however, are higher than these other studies,and, thus a response rate of less than 10% is anticipated.Therefore, an extract of 14,000 names and addresses -7,000 from each of the Federal electoral divisions ofCapricornia (Rockhampton, QLD) and Werriwa (SouthWestern Sydney, NSW) - matched by age and gender,was obtained from the AEC electoral roll. A number ofother recruitment methods will also be utilised to sup-plement the primary recruitment method and to recruita diverse range of participants. These methods includeadvertising in local print media, calling former researchparticipants who had registered their interest in participat-ing in future research, and messages delivered throughuniversity email lists.EligibilityTo be eligible for the study, individuals must live orwork in South Western Sydney (New South Wales) orRockhampton (Queensland), be willing to increase theamount of physical activity that they are currently takingpart in, and be over 18 years of age. Participants will beexcluded from the project if:1. They do not have access to the Internet.2. Are unable to speak/read English.3. They are currently engaging in moderate-to-vigorousPA (MVPA) for 30 minutes on 5 or more days perweek, with the question “As a rule, do you do at leasthalf an hour of moderate or vigorous exercise (such aswalking or a sport) on five or more days a week?” [33].4. They have an existing medical condition which couldbe exacerbated by PA (assessed using the PhysicalActivity Readiness Questionnaire, PAR-Q [34]).5. They have ever been a member of www.10000steps.org.au.Subsequent to the commencement of recruitment,additional screening for participants who self-identifiedas being either too physically active to participate in theAssessed foreligibilityBaseline assessmentRandomisation Allocated to Web 1 group (10,0000 Steps) (n = 168)Allocated to Web 2 group (Walk 2.0)(n = 168)Ineligible:Do not meet inclusion criteriaMeet exclusion criteriaFail to gain medical clearanceAllocated to Control group (Logbook) (n =168)3 month follow up12month follow up18 month follow upFollow upAllocationEnrolment ...Figure 1 Flow diagram of study protocol.Kolt et al. BMC Public Health 2013, 13:436 Page 3 of 9http://www.biomedcentral.com/1471-2458/13/436study or as having an existing chronic medical condition(based on the PAR-Q measure) was introduced andwill be conducted by telephone interview. The ActiveAustralia questionnaire will be used to address potentialrecall bias by confirming the participant’s assessment ofPA [35,36]. Individuals who self-identify as having anexisting chronic medical condition will be invited to gainmedical clearance from their general medical practi-tioner (family physician) to participate in the study, assome people are likely to still benefit from participatingin the study given suitable medical clearance (e.g., thosetaking prescribed blood pressure medications).Study procedureParticipant eligibility will be screened through a self-administered survey that is delivered with a persona-lised invitation letter (AEC-recruited participants) and areply-paid envelope. Online access to the screening sur-vey will also be available for all potential participants. Asindicated above, additional screening concerning PA andhealth status may be needed for some people. All thosedeemed eligible will then be contacted by telephone andinvited to attend an induction session to provide in-formed consent and be fitted with an ActiGraph activitymonitor to measure PA, which they are required to wearfor 7 days. Participants will be asked to complete a logof wear time, showing time that the monitor was put onand taken off each day and the time and reason that themonitor was taken off during the day. When participantsreturn the ActiGraph (at least 8 days later) they will par-ticipate in the baseline measurement session. All mea-surements sessions (baseline, 3, 12 and 18 months) willincorporate anthropometic measures and a self reportquestionnaire (Table 1) and will be conducted at aUniversity campus. ActiGraph monitors will be postedto participants by registered post for 3, 12 and 18 monthfollow ups a week before they attend their measurementsession at the university. Participants will be randomlyallocated to an intervention condition and all parti-cipants will receive a pedometer (Yamax DigiwalkerSW200, Yamasa Tokei Keiki co., Japan) after satisfactor-ily completing the requirements of the baseline measure-ment (valid Actigraph data, completed anthropometricassessments, completed baseline survey). Participants’progress and use of the website will not be monitoredbetween follow-up measurement points.If valid Actigraph data are not collected at a time point,the participant will be asked to wear the ActiGraphactivity monitor for a further 7 days until valid datahave been collected. Anthropometric measurements willbe collected at all time points. If participants miss anassessment point at 3 or 12 months, they will still be in-vited to attend the next subsequent follow-up assess-ment session.Table 1 Summary of measures to be collectedPrimary outcome measures Data collection instrument Collection points (months)Physical activity levels 7 day ActiGraph physical activity monitoring 0, 3, 12 and 18Active Australia Survey [35] 0, 3, 12 and 18Secondary outcome measuresAnthropometric measurements Height Induction, 0, 3, 12 and 18Weight Induction, 0, 3, 12 and 18Abdomen girth [37] Induction, 0, 3, 12 and 18Other measuresSelf reported quality of life SF-36 [38] 0, 3, 12 and 18Psychosocial Correlates Stages of Change [39] 0, 3, 12 and 18Intention [40]Subjective Norm [40]Perceived Behavioural Control [40]Attitude [40]Outcome expectations [41]Self Efficacy [42]Barriers Self Efficacy [42]Self reported Internet self-efficacy Internet self-efficacy scale [43] 0, 3, 12 and 18User satisfaction System Usability Scale [44] 3, 12 and 18 monthsDescriptive information Demographics questionnaire 0Kolt et al. BMC Public Health 2013, 13:436 Page 4 of 9http://www.biomedcentral.com/1471-2458/13/436InterventionsWeb 1.0 groupParticipants in the Web 1.0 condition will gain access tothe existing 10,000 Steps website (www.10000steps.org.au).The 10,000 Steps website is designed in conjunction withthe use of a pedometer and offers a step log and individualself-monitoring features as well as numerous written(electronic) educational/informational materials [27].These features allow the core functionality of recor-ding steps and monitoring progress over time in aweb-based environment. Communication between par-ticipants on this site is limited to a forum and a vir-tual walking buddy feature which enables a user toshare their step log with another user. In order to re-quest a walking buddy, users must know the email addressof their potential walking buddy and invite them via email;alternatively users can post their email address on thepublic forum and ask to be invited as a walking buddy byinterested individuals. There is no function on the 10,000Steps website that allows users to search for other users.Web 2.0 groupParticipants in the Web 2.0 condition will have access toa newly developed website (Walk 2.0) featuring Web 2.0features The Walk 2.0 website has been developed toreplicate the core functionality of the 10,000 Stepswebsite with additional Web 2.0 features. These additio-nal features have been developed around blogs, GoogleMash-ups, social networking, and other Web 2.0 architec-ture. The website, when used with a pedometer, allowscore functionality of recording steps and monitoringprogress over time in a web-based environment whilefacilitating contact between participants through ‘statusupdates’, streams, blogs, virtual walking groups, internalemails, and forum posts. Participants have their ownhome page, allowing them to access specific informa-tion about their progress and personalised features for thesite, such as mapping their favourite walks using a Google‘mashup’ tool, ‘friend’ other users, access their friend’s con-tent (providing consent has been obtained), and inviteoutside friends and family, who will be able to use thewebsite but not be involved in the trial, to join the site.Users also have a profile page which allows them to shareselected information with their ‘friends’ on the site. Accessto the Web 2.0 platform will be restricted to those in theWeb 2.0 arm and other individuals that participants inviteto join them on the site.Control groupParticipants in the Control condition will have access to apaper-based log book and will be directed not to registeror use the publicly available 10,000 Steps website. The logbook provides participants with an overview of the keymessages available through the other interventions, suchas instruction in goal setting and increasing opportunitiesfor PA and health gain, and a means of recording stepsand monitoring progress over time. Each log book coversa period of 3 months and participants will receive enoughlog books at each follow-up measurement point to sus-tain their involvement in the project until the followingmeasurement.RandomisationParticipants will be randomly assigned to one of thethree trial arms using equal groups random allocationperformed through a computer-generated algorithm. Toavoid contamination in cases where participants residein the same household, the first participant will be ran-domly assigned to a trial arm and the other participantsfrom that household will also be allocated to the sametrial arm. Randomisation occurs after the participant hascompleted all baseline measurements. Participants willreceive a standardised introduction to the features of theintervention that they have been assigned to, which willinclude the use of the pedometer, self-monitoring, andsetting goals in all groups; and how to modify accountsettings and access important features such as progressgraphs and charts, forums, and the use of social mediafor the web-based groups.Outcome measurementsPhysical activityPhysical activity will be evaluated using both subjec-tive (Active Australia Survey) and objective (ActiGraphactivity monitor) methods. The Active Australia Surveyassesses both frequency and duration of walking fortransport and recreation and MVPA [35]. The ActiveAustralia Survey has established acceptable test-retestreliability and validity in the Australian adult population,and has been documented as a useful evaluative tool fordetecting intervention related change in PA behaviours[36,45,46]. The ActiGraph activity monitor (ActiGraphGT3X, http://www.theActiGraph.com) will be used toobjectively measure minutes of MVPA. The GT3X willbe affixed to an elastic belt and worn on the waist. Thevalidity and reliability of the GTX3 has been shown tobe similar to the Actigraph GT1M devices in laboratorytesting and for the measurement of everyday activities[47,48]. The reliability and validity of GT1M comparedto other commercially available activity monitors hasbeen previously established as [49].During the induction session participants will be ins-tructed on correct wear and fitting of the ActiGraph ac-tivity monitor. Participants will be asked to wear theunit over their right hip at the point of the anterior su-perior iliac spine, and fastened with the supplied elasticwaist band. Participants will also be asked to completean activity monitor log detailing times the monitor wasKolt et al. BMC Public Health 2013, 13:436 Page 5 of 9http://www.biomedcentral.com/1471-2458/13/436removed and activities undertaken when the Actigraphwas not worn. The Activity monitor will be worn for 7full days during waking hours, except when swimmingor bathing and participating in contact sports. Triaxialdata are collected in 1 second epochs along with stepcounts and inclinometry. When participants attend theirbaseline appointment at least 8 days later, the activitymonitor data will be inspected. For the purposes of thisstudy, valid wear time will be determined as at least 600minutes wear time per day on 5 days. Wear time will beevaluated using the criteria of 60 minutes of consecutivezero data and a 2 minute spike tolerance [50]. Partici-pants with invalid data will be asked to wear the activitymonitor for a further 7 days. If, for the baseline meas-urement, a participant refuses or if they agree but returninvalid data up to three times, they will be excludedfrom the study but allowed to continue using the web-site. Participants with valid data will then complete abaseline survey before being randomised to their trialintervention.For 3, 12 and 18 month outcome measurements, acti-vity monitors and wear log sheets will be delivered toparticipants using registered post. Receipt of the activitymonitor will be confirmed by telephone and participantswill also be contacted by telephone 2–3 days prior to theappointment to check wear compliance and confirm thescheduled follow-up appointment. If the participant re-ports compliance with expected wear of the activitymonitor they will then attend the University where weartime will be validated according to the protocol describedat baseline. If the participant reports non-compliance withthe expected wear of the activity monitor, the monitor willbe left with them for a minimum of a further 5 days, dur-ing which time they will be expected to wear the monitorto comply with project requirements. If the participantchooses not to wear the ActiGraph again they will beasked to complete the outcome survey and will not be ex-cluded from the project.Anthropometric measurementsHeight, weight, and abdomen girth will be measuredat all outcome measurement sessions by project staff.Weight and height will be measured with the participantstanding normally, with feet together and head in theFrankfurt plane, using Seca 700 mechanical balancescales and a Seca 220 measuring rod (Seca GmbH,Hamburg). Participants will be asked to remove theirshoes and any heavy personal items/items of clothingfor the measurement. Abdomen girth will be mea-sured from as the ellipse projected on the transverseplane using the bilateral iliac crests as antipodal tan-gents using the Seca 203 measurement tape in ac-cordance with the NIH protocol [37].Other measuresWebsite usage, engagement, and retention for the Web1.0 and Web 2.0 intervention groups will be measuredusing a commonly available web traffic analysis platform(Google analytics) and monitoring of user-generated con-tent. Features monitored will include: Number of logins Frequency of step log use (and steps logged) Use of site stream (status updates, and commentson ‘friends’ stream) Page visits Goals set Time on website Number of friends (Web 2.0 only) Number of blog postsIn the Control group, logbooks will also be collectedto enable comparison in use of common features (e.g.,step log, goal setting) between interventions.Quality of life will be assessed with the RAND 36 itemShort Form Health Survey (SF-36) which evaluates 8health concepts including limitations in physical activ-ities and usual role activities because of health problems,bodily pain, general mental health, and vitality (energyand fatigue). The SF-36 has been validated on Australianpopulations [51], has demonstrated suitability for use inthe general population [52,53], and is associated with thestage of motivational readiness to changes in physical ac-tivity [54,55].Participants’ confidence in their ability to execute tasksand trouble shoot problems with the Internet will bemeasured using the Internet Self-Efficacy Scale (ISES).The effect of Internet self-efficacy is poorly understoodin terms of Internet-delivered PA programs. The ISESuses 8 items assessed on a 7-point likert scale to assess auser’s understanding of Internet hardware and software,confidence in gathering information using the Internetand learning skills to use Internet programs, and abilityto troubleshoot and resolve Internet problems. The ISEShas shown good reliability and internal consistency [43].A brief psychosocial questionnaire was used to assesskey variables pertinent to follow-up analyses of interven-tion mediation and moderation. These variables includecore constructs from the Transtheoretical Model (TTM[56]), Social Cognitive Theory (SCT [41]), and Theory ofPlanned Behavior (TPB [40]), and have been constructedto align with the target behaviour of taking 10,000 stepsper day. From the TTM, Stages of Change is assessed bywhether participants are currently taking 10,000 stepsper day; if so how long they have been doing so; if not,whether they intend to, or are preparing or beginning totake 10,000 steps per day. This 6-item Stages of Changemeasure was modelled on a previously published scaleKolt et al. BMC Public Health 2013, 13:436 Page 6 of 9http://www.biomedcentral.com/1471-2458/13/436[39]. From SCT, we developed a specific set of 4 itemsto assess self-efficacy for taking 10,000 steps per day, aswell as a set of 10 items to assess self-efficacy to over-come common barriers to taking steps from existingguidelines [42]. A set of 9 items was used collectively toassess agreement with the SCT construct of outcome ex-pectations associated with taking 10,000 steps per day.From TPB, we assessed intention with 2 items, subjec-tive norm with 2 items, perceived behavioural controlwith 2 items, and attitude with 4 items, all with regardto being physically active at a level of taking 10,000 stepsper day. These TPB constructs were tailored to the tar-get behaviour of 10,000 steps per day, based on a set ofpreviously published items [57].Overall user satisfaction of the assigned interventionwill be investigated at all follow-up time points using theSystem Usability Scale [44].Statistical power and sample sizeSample size for the RCT is based on the primary out-come measure, minutes of MVPA, as measured by theActiGraph accelerometer. A review of web-based PA in-terventions suggests that studies which do not includeaspects of Web 2.0 had a small effect on change in PAstatus of participants and had a dropout rate of approxi-mately 40% [15]. Given the enhanced effects of the Web2.0 intervention expected on the PA status of partici-pants, the current study will be powered to detect asmall to moderate change in minutes of MVPA. There-fore, to achieve 80% power to detect a small to mode-rate difference in PA between groups (control/Web 1.0/Web 2.0) at any given time point, approximately 120participants per group will be required using an alphalevel of 0.05. The number of participants per group hasbeen inflated by 40% (n=168/group) to account for par-ticipant drop out while retaining adequate power toachieve study aims at 18 months.Statistical analysisAll analyses will follow intention to treat principles. Maincomparison between groups will be performed using ge-neral linear mixed modelling. The impact of missing datawill be addressed using multiple imputation. The samplesize is inflated to incorporate the additional uncertaintyarising from missing data. All analyses will be conductedusing SPSS for Windows (Version 15.0). The level of sig-nificance (alpha) will be set at 0.05.DiscussionThe current trial presents a unique opportunity to studythe effectiveness of new generation web based appli-cations (Web 2.0) in social marketing and health pro-motion using a conventional (Web 1.0), established, andongoing PA promotion program (10,000 Steps Australia)as a comparator. Each year there is a proliferation ofhealth-related and health promotion websites, yet verylittle work has been carried out to study the utility andeffectiveness of these population-targeted websites [58].Research studying the effectiveness of this now pervasivecommunication medium has been limited to studies ofshort duration and at times modestly sized samples [15],with many lacking any comparative study of websitecomponents [14]. We expect that the current study’sfindings will provide increased understanding of thebenefits of new web-based technologies and applicationsin engaging and retaining participants on web-based in-tervention sites, with the aim of improved and main-tained health outcomes as a result of increased websiteengagement and retention.AbbreviationsAEC: Australian Electoral Commission; ISES: Internet self efficacy survey;MVPA: Moderate-to-vigorous physical activity; PA: Physical activity;PAR-Q: Physical activity readiness questionnaire; RCT: Randomised controlledtrial; SCT: Social cognitive theory; SF-36: Short form health survey;TPB: Theory of planned behaviour; TTM: Transtheoretical model.Competing interestsThe authors declare that they have no competing interests.Authors’ contributionsWKM, GSK, AJM, CV, MJD, and CMC, conceived the project and procured theproject funding. GSK is leading the coordination of the trial. GSK, RRR, AJM,CV, MJD, CMC, and WKM assisted with protocol design. TNS is managing thetrial including data collection with the assistance of CH. AJM and RTdeveloped the IT platform for the trial and MJD performed the sample sizecalculations. GSK, RRR, and TNS drafted the manuscript and all authors read,edited, and approved the final manuscript.AcknowledgementsThis trial is being funded by the National Health and Medical ResearchCouncil (Project Grant number 589903). The funder does not have any rolein the study other than to provide funding.CV was supported by a National Health and Medical Research Council(#519778) and National Heart Foundation of Australia (#PH 07B 3303) post-doctoral research fellowship during the conception of the research projectand recruitment.Author details1University of Western Sydney, School of Science and Health, Sydney, NSW,Australia. 2Department of Human Nutrition, Kansas State University,Manhattan, KS, USA. 3University of Western Sydney, School of Computing,Engineering and Mathematics, Sydney, NSW, Australia. 4Central QueenslandUniversity, Institute for Health and Social Science Research, Rockhampton,Queensland, Australia. 5University of British Columbia, School of Health andExercise Sciences, Kelowna, British Columbia, Canada. 6University of Alberta,Faculty of Physical Education and Recreation, Edmonton, Alberta, Canada.Received: 26 April 2013 Accepted: 30 April 2013Published: 3 May 2013References1. 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Health Promot J Austr 2008,19(1):29–35.doi:10.1186/1471-2458-13-436Cite this article as: Kolt et al.: WALK 2.0 - Using Web 2.0 applications topromote health-related physical activity: A randomised controlled trialprotocol. BMC Public Health 2013 13:436.Submit your next manuscript to BioMed Centraland take full advantage of: • Convenient online submission• Thorough peer review• No space constraints or color figure charges• Immediate publication on acceptance• Inclusion in PubMed, CAS, Scopus and Google Scholar• Research which is freely available for redistributionSubmit your manuscript at www.biomedcentral.com/submitKolt et al. BMC Public Health 2013, 13:436 Page 9 of 9http://www.biomedcentral.com/1471-2458/13/436

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